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. 2021 Jun 23;16:1913–1924. doi: 10.2147/COPD.S311178

Table 1.

Checklist for the Technical Assessment of HAN/TUR/DIS Inhaler Use

The steps of HAN

  1. Open the dust cap by pulling it upwards, then open the mouthpiece.

  2. Place the capsule in the center chamber.

  3. Close the mouthpiece firmly until hearing a click, leaving the dust cap open.

  4. Keep the mouthpiece upwards, then press the piercing button completely in 1 time and release.

  5. Breathe out completely, do not exhale into the mouthpiece*.

  6. Close your lips tightly around the mouthpiece, breathe in rapidly and steadily, as deeply as possible, and you should hear the capsule rattle*#.

  7. Hold your breath*.

  8. Breathe normally after holding breath*.

  9. To ensure you get the full dose, repeat the inhalation from the HAN as described.

  10. After the dose, open the mouthpiece, tip out the used capsule, and throw it away. Close the mouthpiece and dust cap for storage.

  11. Clean the device once a month and let it dry completely before use.

The steps of TUR

  1. Twist and remove the cover.

  2. Hold the inhaler upright with the mouthpiece facing up.

  3. Turn the grip right and left until it clicks.

  4. Breathe out completely, do not exhale into the mouthpiece*.

  5. Breathe in rapidly and steadily, as deeply as possible*#.

  6. Hold breath*.

  7. Breathe normally after holding breath*.

  8. Close the cover.

  9. If a second dose is needed, separate the two doses for 30 seconds, and repeat the operation as above.

  10. Gargle after inhaling ICS-containing drugs.

  11. Know how to judge the remaining dose.

  12. Keep the medicine in a dry place.

The steps of DIS

  1. Hold the inhaler in one hand and face the metering window, and place the thumb of the other hand on the inhaler thumb handle and push it.

  2. Pull down the slide bar with the thumb, then will hear a “click”.

  3. Breathe out completely, do not exhale into the mouthpiece*.

  4. Breathe in rapidly and steadily, as deeply as possible*#.

  5. Hold breath*.

  6. Breathe normally after holding breath*.

  7. Close the cover (no need to return the slide bar).

  8. If a second dose is needed, separate the two doses for 30 seconds, and repeat the operation as above.

  9. Gargle after inhaling ICS-containing drugs.

  10. Know how to judge the remaining dose.

  11. Keep the medicine in a dry place.

Notes: *These steps were the breathing-related steps. #Instead of using observation evaluation, but use peak flow rate evaluation by In-Check Dial.

Abbreviations: HAN, HandiHaler®; TUR, Turbuhaler®; DIS, Diskus®.